Citation Nr: 0813851 Decision Date: 04/25/08 Archive Date: 05/01/08 DOCKET NO. 04-11 973A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to service connection for a neck disability, to include on a secondary basis. 2. Entitlement to service connection for an upper back disability, to include on a secondary basis. 3. Entitlement to a rating in excess of 40 percent for a low back disability. 4. Entitlement to a total rating based on individual unemployability (TDIU). REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD K. R. Fletcher, Counsel INTRODUCTION The appellant is a veteran who served on active duty from July 1977 to March 1980. These matters are before the Board of Veterans' Appeals (Board) on appeal from July 2003 and June 2006 rating decisions by the Philadelphia, Pennsylvania Department of Veterans Affairs (VA) Regional Office (RO). In May 2007, a Travel Board hearing was held before the undersigned. A transcript of the hearing is associated with the claims file. This case was before the Board in September 2007 when it was remanded for additional development. The issues of entitlement to service connection for neck and upper back disabilities and to TDIU are being REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if any action on her part is required. FINDING OF FACT The veteran's service connected low back disability is not shown to be manifested by ankylosis, separately ratable neurological symptoms, or incapacitating episodes of 6 weeks or more in the past 12 months. CONCLUSION OF LAW A rating in excess of 40 percent is not warranted for the veteran's service-connected low back disability. 38 U.S.C.A. §§ 1155, 5107 (West 2002 &. Supp. 2007); 38 C.F.R. § 4.71a, Diagnostic Codes (Codes) 5286, 5289, 5292, 5293, 5295 (as in effect prior to September 26, 2003); 38 C.F.R. §§ 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, Codes 5235-5243 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION I. Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The VCAA applies to the matter addressed herein. Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in his or her possession that pertains to the claim. 38 C.F.R. § 3.159(b)(1). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). With respect to the claim decided herein, the veteran was provided content-complying notice by letter in May 2003, prior to the initial adjudication of the claim in July 2003. The letter explained the evidence necessary to substantiate the claim, the evidence VA was responsible for providing, and the evidence the appellant was responsible for providing. Although the May 2003 letter did not specifically inform the appellant to submit any pertinent evidence in her possession, it informed her of the evidence required to substantiate her claim and that she should submit such evidence or provide the RO with the information necessary for the RO to obtain such evidence on her behalf. She has had ample opportunity to respond. In a December 2007 Supplemental Statement of the Case (SSOC), the veteran was given notice regarding ratings and effective dates of awards. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 490-91 (2006). The Board is aware that the Statement of the Case and the SSOCs do not contain the level of specificity set forth in Vazquez- Flores v. Peake, No. 05-0355 (U.S. Vet. App. January 30, 2008). However, the Board does not find that any such procedural defect constitutes prejudicial error in this case because of evidence of actual knowledge on the part of the veteran and other documentation in the claims file reflecting such notification that a reasonable person could be expected to understand what was needed to substantiate the claim. See Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007). In this regard, the Board notes the veteran's statements during 2003, 2004, 2006 and 2007 VA examinations, 2005 and 2007 personal hearings, and in a June 2003 statement, which indicate an awareness on her part that information demonstrating a noticeable worsening or increase in severity of the disability and the effect of that worsening has on the veteran's employment and daily life is necessary to substantiate a claim for a higher evaluation. Significantly, the Court in Vazquez-Flores held that actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what was necessary to substantiate his or her claim." Id., slip op. at 12, citing Dalton v. Nicholson, 21 Vet. App. 23, 30-31 (2007). The veteran has had ample opportunity to respond/supplement the record. Neither the veteran nor her representative alleges that notice has been less than adequate. Regarding VA's duty to assist, all appropriate development to obtain the veteran's pertinent medical records has been completed. All available, pertinent post-service treatment records have been obtained, and all evidence constructively of record (VA medical records) has been secured. The veteran has not identified any pertinent evidence that remains outstanding. The RO arranged for VA examinations on several occasions, including in 2003, 2004, 2006 and 2007. The veteran provided testimony in support of her claim at hearings before a Decision Review Officer in April 2005 and before the Board in May 2007. Evidentiary development is complete. VA's duties to notify and assist are met. Accordingly, the Board will address the merits of the claim. II. Factual Background In May 2003, the veteran submitted a claim for an increased (greater than 40 percent) rating for her service-connected low back disability. A June 2003 VA orthopedic examination report notes the veteran's complaints of constant pain in her low back and occasional pain in the legs. She indicated that repetitive movements made her pain worse. She denied any associated numbness, weakness, or bladder/bowel dysfunction. She was not currently using any canes, crutches, walkers, or braces. Examination of the low back revealed limitation of motion of forward flexion to 55 degrees, extension to 25 degrees, and lateral bending to 34 degrees bilaterally, all limited by pain and stiffness. Distracted straight leg raising brought on some symptoms of radiculopathy into the thighs bilaterally. X-rays of the lumbar spine revealed osteoarthritic changes and spondylolithesis at L5. On VA orthopedic examination in July 2004, the veteran described pain like "a ball of fire" in her low back. She reported difficulty getting up from a chair. She also reported periodic flare-ups of back pain and leg weakness with increased activity. She denied bowel or bladder problems, or any episodes of incapacitation. She did not use any assistive devices such as canes or walkers. Upon examination, there did not appear to be any deviation of the spine. Range of motion was limited to 64 degrees of flexion, 19 degrees of extension, 42 degrees of left lateral flexion, 23 degrees of right lateral flexion, and 55 degrees of lateral rotation, bilaterally. Muscle strength was 5/5 in the lower extremities; there was no decrease in sensation. Lasegue's sign seemed to be mildly positive on the left side; straight leg raising was negative. A March 2006 VA examination report notes the veteran's complaint of constant low back pain since falling during her military service. She reported two recent falls after missing steps on the stairs. She denied bowel or bladder problems; she reported monthly leg or foot weakness, but denied numbness. She also reported weekly flare-ups of back pain after increased activity. On examination, the veteran's posture and gait were normal. There was no evidence of muscle spasm, atrophy, or weakness. Pain was moderate with motion. Active range of motion of the thoraco-lumbar spine was: flexion 0 to 60 degrees; extension 0 to 12 degrees with pain beginning at 12 degrees and ending at 0 degrees; left lateral flexion 0 to 30 degrees; right lateral flexion 0 to 25 degrees, with pain beginning at 25 degrees and ending at 9 degrees; left lateral rotation 0 to 35 degrees, with pain beginning at 35 degrees and ending at 15 degrees; and right lateral rotation 0 to 40 degrees. Passive flexion was 0 to 65 degrees, with pain beginning at 65 degrees and ending at 45 degrees. Considering functional loss due to pain and other factors, flexion was from 0 to 32 degrees, extension was from 0 to 4 degrees, right lateral flexion was from 0 to 11 degrees, left lateral rotation was from 0 to 30 degrees, and right lateral rotation was from 0 to 20 degrees. Sensory examination revealed no abnormal sensations; muscle tone was normal. Lasegue's sign was negative. The diagnoses included degenerative disease, antherolisthesis and spondylolysis. A private MRI report dated in September 2006 revealed very significant degenerative disc disease and degenerative spondylolisthesis of the lumbar spine, as well as a posterior disc bulge at L4-5. An October 2007 VA neurological examination report notes the veteran's complaints of low back pain. Examination revealed no objective neurological abnormalities due to the veteran's service-connected low back disability. Specifically, there was no paralysis of any nerve in the lower extremity or any obvious paralysis to large group of nerves or brachial plexus or root-level paralysis. Sensory examination was indicative of underlying generalized peripheral polyneuropathy which was thought to be related to the veteran's diabetes mellitus. A November 2007 VA orthopedic examination report notes the veteran's complaints of constant severe low back pain with radiation to the legs. She reported having flare-ups sufficient to confine her to bed for four days. These flare- ups occurred three times over a period of six months. In addition, she reported weakness and tingling in her legs, as well as constipation. Upon examination, the veteran reported diffuse tenderness over the thoracolumbar spine. Range of motion testing was repeated three times without significant change. Specifically, flexion ranged from 53 to 46 degrees, extension was to 30 degrees, left lateral flexion ranged from 24 to 27 degrees, right lateral flexion ranged from 20 to 18 degrees, left lateral rotation was to 30 degrees and right lateral rotation was to 30 degrees. Straight leg raise was mildly positive on the left at 90 degrees. The veteran was able to walk on her heels and toes. The examiner opined that additional functional loss during flare-ups could not be quantified. The examiner stated: The veteran is significantly handicapped by her low back as well as other problems in employability. However, I believe there are some occupations which she is capable of doing. I therefore believe that she is not completely unemployable. Records from the Social Security Administration (SSA) show that the veteran had been rated as disabled, with degenerative disc disease noted as her primary disability and depression noted as her secondary disability, effective November 1997. III. Criteria and Analysis Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. When a question arises as to which of two ratings under a Diagnostic Code applies, the higher evaluation is assigned if the disability picture more closely approximates the criteria for the higher rating; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. At the outset, it is noteworthy that the portion of the Rating Schedule pertaining to evaluation of disabilities of the spine was amended during the pendency of this appeal. From their effective date the veteran is entitled to a rating under the revised criteria (if such are found more favorable). Under the criteria in effect prior to September 26, 2003, lumbosacral strain was evaluated under Code 5295, limitation of motion of the lumbar spine was evaluated under Code 5292, and intervertebral disc syndrome was evaluated under Code 5293. A (maximum) 40 percent rating was warranted for severe lumbosacral strain with listing of the whole spine to the opposite side; positive Goldthwaite's sign, marked limitation of forward bending in a standing position, loss of lateral motion with osteo-arthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal mobility on forced motion. 38 C.F.R. § 4.71a, Code 5295 (2003). Under the criteria in effect prior to September 26, 2003, limitation of motion of the lumbar spine warrants a (maximum) 40 percent rating if it is severe. 38 C.F.R. § 4.71a, Code 5292 (2003). [As ankylosis or complete bony fixation of the spine is not shown, Codes 5289, 5286 do not apply.] Under the criteria in effect prior to September 26, 2003, intervertebral disc syndrome is evaluated (preoperatively or postoperatively) either on the total duration of incapacitating episodes over the past 12 months, or by combining under 38 C.F.R. § 4.25 (combined rating tables) separate evaluations of its chronic orthopedic and neurological manifestations along with evaluations for all other disabilities, which ever method results in the higher evaluation. A maximum 60 percent rating is warranted when rating based on incapacitating episodes, and such is assigned when there are incapacitating episodes having a total duration of at least six weeks during the past 12 months. A 40 percent evaluation is assigned for incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months. 38 C.F.R. § 4.71a, Code 5293 (2003). Note 1 provides that for the purposes of ratings under Code 5293, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. "Chronic orthopedic and neurological manifestations" means orthopedic and neurological signs and symptoms resulting from intervertebral disc syndrome that are present constantly, or nearly so. Note 2 provides that when evaluating on the basis of chronic manifestations, evaluate orthopedic disabilities using evaluation criteria for the most appropriate orthopedic diagnostic code or codes. Evaluate neurological disabilities separately using evaluation criteria for the most appropriate neurological diagnostic code or codes. 38 C.F.R. § 4.71a, Code 5293 (2003). In determining the degree of limitation of motion, the provisions of 38 C.F.R. §§4.10, 4.40 and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more of less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. Under the criteria effective September 26, 2003, lumbosacral strain, degenerative arthritis of the spine and intervertebral disc syndrome are each rated under the General Rating Formula for Rating Diseases and Injuries of the Spine (General Rating Formula, outlined below). 38 C.F.R. § 4.71a, Codes 5237, 5242 and 5243 (2007). Under the General Rating Formula, effective September 26, 2003, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. There are several notes set out after the General Rating Formula criteria, which provide the following: Neurological abnormalities are to be rated separately under an appropriate diagnostic code. For purposes of VA compensation, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateroflexion is 0 to 30 degrees, and left and right lateral rotation is 0 to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateroflexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is to 240 degrees. In exceptional cases, an examiner may state that, because of age, body habitus, neurological disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in the regulation. Each range of motion should be rounded to the nearest 5 degrees. Once the evidence is assembled, the Board is responsible for determining whether the preponderance of the evidence is against the claim. If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). As noted above, the veteran is already at the maximum schedular rating (40 percent) under Codes 5295 and 5292. In addition, the medical evidence shows that the veteran retains substantial useful motion of her low back. Therefore, a higher rating on the basis of complete bony fixation of the spine or ankylosis is not warranted under Code 5286 or Code 5289. With regard to Code 5293, the medical evidence of record does not show incapacitating episodes having a total duration of at least six weeks during the past 12 months. Although the veteran indicated in 2007 that she had about 12 days of incapacitating episodes in the past six months, the record does not show that the veteran was placed on bed rest for her low back disability by a physician. Even if the 12 days described by the veteran had been prescribed by a physician, this would fall short of the six weeks over 12 months needed for a rating in excess of 40 percent. Therefore, a rating based on incapacitating episodes is not indicated. Moreover, although Code 5293 provides that the veteran may be rated based on a combination of orthopedic and neurological symptoms, the Board notes that neurological symptoms due to the low back disability are not shown. The October 2007 VA examiner stated that examination revealed no objective neurologic abnormalities due to the veteran's service-connected low back disability. Specifically, there was no paralysis of any nerve in the lower extremity or any obvious paralysis to large group of nerves or brachial plexus or root-level paralysis. Generalized peripheral polyneuropathy was found to be due to the veteran's diabetes mellitus; such symptoms may not be considered in rating the low back disability. As the current 40 percent rating is the maximum provided for orthopedic symptoms by the pre-September 26, 2003 criteria (Codes 5295 and 5292), a rating based on a combination of ratings for orthopedic and neurological symptoms would be of no benefit to the veteran. The Board finds, therefore, that the criteria for a rating greater than 40 percent for the veteran's low back disability under Code 5293 are not met. Likewise, with respect to the revised General Rating Formula criteria (General Formula), a rating in excess of 40 percent would be warranted if there was unfavorable or favorable ankylosis of the entire thoracolumbar spine. Such pathology is not shown. The criteria under the General Formula also provide for rating neurological symptoms separately. As was previously noted, although the veteran has complained of neurological symptoms, objective neurological findings due to the veteran's low back disability are not shown. The criteria for rating disc disease have been renumbered (now Code 5243). They provide for rating based on incapacitating episodes (criteria essentially unchanged from those in effect prior to September 26, 2003). Again, as incapacitating episodes are not shown, a rating on that basis is not warranted. On close review of the entire record the Board found no distinct period during which the criteria for a higher (in excess of 40 percent) rating were met. See Hart v. Mansfield, 21 Vet. App. 505 (2007), The Board has considered the evidentiary rule requiring that reasonable doubt be resolved in a claimant's favor (38 C.F.R. § 3.102). However, as the preponderance of the evidence is against this claim, that rule does not apply. ORDER A rating in excess of 40 percent for a low back disability is denied. REMAND Regarding the claims of service connection for neck and upper back disabilities on a secondary basis, the Board notes that service connection may be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310(a). In addition, service connection may be established on a secondary basis for a disability which is aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). However, the veteran may only be compensated for the degree of disability over and above the degree existing prior to the aggravation. Id. Temporary or intermittent flare-ups of symptoms of a condition, alone, do not constitute sufficient evidence of aggravation unless the underlying condition worsened. Cf. Davis v. Principi, 276 F. 3d 1341, 1346-47 (Fed. Cir. 2002); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). The veteran's neck and upper back disabilities were not manifested in service or in the first post-service year, and she does not allege otherwise. Her claims of service connection for these disabilities are premised on a theory of causality attributing the disabilities to her low back disability. Records show the veteran has degenerative changes of the cervical spine and mild lower thoracic disc degeneration and thoracic scoliosis. A June 2007 opinion from Dr. B essentially states that the neck and upper back problems may be worsened by the veteran's service-connected low back disability. No reasons and bases for this opinion are provided. Furthermore, Dr. B's opinion is not stated in terms of sufficient probability (i.e., at least as likely as not) to substantiate the veteran's claims. In the September 2007 remand, the Board specifically instructed the RO to schedule the veteran for a VA orthopedic examination to determine whether neck and upper back disabilities were as likely as not either caused or chronically worsened by her service-connected low back disability. Review of the claims file found that this development was not accomplished. On November 2007 VA orthopedic examination, the examiner opined that he did not see "sufficient evidence to connect the thoracic complaints and cervical complaints to the low back and the fall that occurred in (service). Therefore, . . . it is not as likely as not that the veteran's cervical problems and thoracic problems (upper back) are related to her service." Notably, the examiner did not address whether the veteran's service-connected low back disability aggravated the disabilities for which service connection is sought; see Allen, supra. A remand by the Board confers on the appellant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). Given that the 2007 VA opinion did not fully conform to the Board's remand instructions, the case must once again be sent back to the RO. The Board also notes that a revised version of 38 C.F.R. § 3.310 became effective October 10, 2006. The revised version essentially provides that VA will not concede aggravation of a non service-connected disease or injury by a service-connected disease or injury unless the baseline level of severity is established by medical evidence. The regulation further sets out the procedure for determining the extent of any aggravation. Attention of the RO and the VA examiner is directed to these changes so that the report of the VA examination directed by the Board includes the necessary information. Moreover, the veteran should have written notice of the new regulation. The claim seeking TDIU is inextricably intertwined with the claims of service connection for neck and upper back disabilities. Hence, adjudication of the TDIU claim must be deferred pending resolution of those claims. Accordingly, the case is REMANDED for the following action: 1. The RO should provide the veteran with written notice of the amendments to 38 C.F.R. § 3.310(b), effective as of October 10, 2006. 2. Thereafter, the RO should arrange for the veteran to be examined by an orthopedist to determine whether her neck and upper back disabilities are related to her service-connected low back disability. The veteran should be properly notified of the examination and of the consequences of a failure to appear. Her claims file must be reviewed by the examiner in conjunction with the examination, and any indicated studies or tests should be accomplished. All clinical findings should be reported in detail. Based on review of the veteran's pertinent medical history and with consideration of sound medical principles, the examiner should provide the following opinions: a. Is it at least as likely as not (50 percent or better probability) that the veteran's neck disability was caused or aggravated (i.e., chronically worsened) by her service-connected low back disability. If the examiner finds that the veteran's neck disability was not caused, but was aggravated by her service-connected low back disability, the examiner should report the baseline level of severity of the neck disability prior to the onset of aggravation, or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity. If some of the increase in severity of the neck disability is due to natural progress, the examiner should indicate the degree of such increase in severity due to natural progression. See generally 38 C.F.R. § 3.310(b) (effective October 10, 2006). b. Is it at least as likely as not (50 percent or better probability) that the veteran's upper back disability was caused or aggravated (i.e., chronically worsened) by her service-connected low back disability. If the examiner finds that the veteran's upper back disability was not caused, but was aggravated by her service-connected low back disability, the examiner should report the baseline level of severity of the upper back disability prior to the onset of aggravation, or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity. If some of the increase in severity of the upper back disability is due to natural progress, the examiner should indicate the degree of such increase in severity due to natural progression. See generally 38 C.F.R. § 3.310(b) (effective October 10, 2006). The examiner should explain the rationale for all opinions expressed. 3. The RO should undertake any other development it determines to be warranted. Then the RO should re- adjudicate the claims of service connection for neck and upper back disabilities, to include on a secondary basis, and TDIU. The provisions of 38 C.F.R. § 3.310(b) (effective October 10, 2006) should be applied, if pertinent. If any claim remains denied, the RO should issue an appropriate Supplemental Statement of the Case and provide the veteran and her representative the opportunity to respond. The case should then be returned to the Board, if in order, for further review. The appellant has the right to submit additional evidence and argument on the matters that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). ______________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs